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Rituximab-associated PRES in antibody-mediated kidney rejection: A case report
Masoud Etemadifar1, Seyyed-Ali Alaei1, Elahe Saffari1
1School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Transplant Immunology
|July 28, 2023
Summary
Posterior Reversible Encephalopathy Syndrome (PRES) can occur in kidney transplant patients. This case highlights rituximab therapy as a potential trigger for PRES, even with standard immunosuppressants.
Area of Science:
- Neurology
- Nephrology
- Immunology
Background:
- Posterior Reversible Encephalopathy Syndrome (PRES) is a rare neurological condition with diverse symptoms.
- Kidney transplant recipients are at risk for PRES, often linked to immunosuppressants like rituximab.
- Antibody-mediated kidney allograft rejection necessitates specific treatment protocols.
Observation:
- A 29-year-old male kidney transplant recipient developed PRES symptoms including headache, nausea, and photophobia.
- The patient had received rituximab therapy to manage antibody-mediated kidney rejection, alongside tacrolimus and mycophenolate mofetil.
- Brain MRI confirmed PRES findings, with symptoms resolving after hospitalization.
Findings:
- Rituximab therapy, used for antibody-mediated kidney rejection, was associated with the onset of PRES in this patient.
- The patient's PRES symptoms resolved after discontinuation of rituximab and supportive care.
- Standard immunosuppressants (tacrolimus, mycophenolate mofetil) did not prevent PRES development during rituximab treatment.
Implications:
- Rituximab may induce endothelial dysfunction, potentially contributing to PRES development in kidney transplant patients.
- Further research is needed to clarify the role of rituximab in PRES development, especially in combination with other immunosuppressants.
- This case underscores the importance of monitoring for PRES in kidney transplant patients undergoing rituximab therapy for rejection.
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